Healthcare Provider Details

I. General information

NPI: 1588367379
Provider Name (Legal Business Name): JIAHE ZHAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 2ND ST
HACKENSACK NJ
07601-2191
US

IV. Provider business mailing address

92 2ND ST
HACKENSACK NJ
07601-2191
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-5855
  • Fax:
Mailing address:
  • Phone: 347-888-6952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA13092000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: